Monday, June 1, 2015

YIN DEFICIENCY AND EMPTY HEAT

Empty Heat derives from Yin deficiency and the two pathological conditions (Yin deficiency and Empty Heat) are often considered as one.  All modern Chinese books include Empty Heat clinical manifestations under the patterns of Yin deficiency.  For example, under the pattern of Lung-Yin deficiency they will have dry throat and dry cough (Yin deficiency) and 5-palm heat (Empty Heat).

This is not the case in practice as Yin deficiency may last a long time without symptoms or signs of Empty Heat: thus, Yin deficiency and Empty Heat are two separate pathological conditions, even though, of course, the latter derives from the former.

The symptoms of Yin deficiency vary according to the organ involved but generally they will include night-sweating and symptoms and signs of dryness such as dry throat, dry cough, dry lips, dry eyes, dry mouth, thirst with desire to drink in small sips, tongue without coating possibly with cracks.

The symptoms and signs of Empty Heat will include feeling of heat (that is worse in the evening), 5-palm heat (a feeling of heat of palms, chest and soles of feet), malar flush, low-grade fever, a red tongue without coating and possibly a rapid pulse.

The tongue shows conditions of Yin deficiency and Empty Heat clearly.  It is important to understand that, although Empty Heat derives from Yin deficiency, it takes time for it to develop.  Therefore, a patient may display all the signs of Yin deficiency on the tongue for several years without developing Empty Heat and the tongue shows this clearly by lacking a coating (Yin deficiency) but being of a normal colour (no Empty Heat).


In fact, Yin deficiency manifests on the tongue with a lack of coating; therefore, a tongue without coating but of a normal body colour indicates Yin deficiency without Empty Heat. As Yin deficiency aggravates with time, Empty Heat may develop and this turns the tongue red: therefore Empty Heat on the tongue is manifested by a red body colour together with the absence of coating.  One often hears that “in Yin deficiency the tongue is red” (a statement that is tempting to make since “in Yang deficiency the tongue is pale”). This is not so: in Yin deficiency, the tongue lacks a coating; in Empty Heat, the tongue lacks a coating and it is red.

No coating, cracks, normal colour = Yin deficiency

No coating, deep red = Yin deficiency with Empty Heat

A tongue without coating indicates Yin deficiency first and foremost of the Stomach: in addition, it may also indicate Yin deficiency of the Kidneys, Liver or Heart.

That Yin deficiency can occur without Empty Heat is demonstrated by tongue diagnosis as many patients have a tongue that lacks a coating (indicating Yin deficiency) but is not red.

Yin deficiency and Empty Heat are not formed in a short space of time: it takes years from them to develop (the only exception is the Yin deficiency and Empty Heat that may form in an acute way during an invasion of Wind-Heat with Heat penetrating into the Interior). The tongue shows clearly not only the present condition but also the stage it is at: it therefore also shows where it is developing from and what it may lead to.



The three stages of the formation of Yin deficiency based on the tongue are:

1) Rootless coating (this is the mildest form of Yin deficiency)
2) Coating partially missing
3) Coating missing completely

Rootless coating = early stage of Yin deficiency
Coating partially missing
Coating missing completely

Coating missing completely, slightly red
 Empty Heat may develop at any of these stages but it is more likely to develop at the third when the tongue has no coating and it is red.

That Yin deficiency and Empty Heat are two separate pathological conditions is clear also from herbal medicine.  In fact, the herbs and formulae that nourish Yin are in a separate category than the herbs and formulae that clear Empty Heat.

For example, Mai Men Dong Tuber Ophiopogonis japonicis and Tian Men Dong Tuber Asparagi cochinchinensis nourish Yin but they do not clear Empty Heat.  Qin Jiao Radix Gentianae Qinjiao and Qing Hao Herba Artemisiae annuae clear Empty Heat.  When there is Empty Heat of course one combines herbs that clear Empty Heat with those that nourish Yin.

Thursday, April 30, 2015

DYSMENORRHOEA CASE HISTORY

The following is a case history sent by Jason Smith in Madrid

Symptoms
A woman aged 43 seeks treatment for painful periods. The periods last three days and are extremely painful. She feels cold in general, but the cold is more intense at period time. 

The period is regular (30 days), lasts 3 days, with little bleeding, and the color is dark red with small clots. The pain is very intense, and is felt around the area of Ren-4/Ren-3. A warm bottle alleviates the pain along with analgesics. The period has always been very painful, especially after the age of 18.

The tongue has a normal color with a thin coating with root. However, the sublingual veins appeared very dark. This patient was a semi professional swimmer, practicing intensely around the age of 13-18.

Diagnosis
The main pattern is a very obvious case of Cold in the Uterus (nature of pain, feeling of cold and alleviation of the pain by a warm bottle). The Cold in the Uterus led to Blood Stasis, as evidenced by the clots, the dark blood and the dark purple sublingual veins.

Treatment
Following the four phases of the menstrual cycle, I decided to center the treatment on phase 4 (pre-menstrual phase), since this is the best time to expel the pathogenic factor, in this case Cold, from the Uterus.

With acupuncture, I used the Chong Mai, with SP-4 and P-6, and a moxa box around the area of Ren-4.

With herbal medicine, the patient was instructed to take four tablets of the Women´s Treasure Warm the Menses, a variation of the classical formula Wen Jing Tang Warming the Menses Decoction by Zhang Zhong Jing.

After the first period, the pain was reduced by about 50%. After the second period, the pain was reduced by a further 25%. After the third period, and up to date, the patient only feels a very slight pain.

For prevention, the patient was instructed to use a moxa box before the period every now and then, to prevent a new invasion of Cold.

Observations
This is a very clear example of how a pathogenic factor can invade the body (after swimming during her puberty, incidentally a time when Chong, Ren and Du are in a very vulnerable state), and remain for about 30 years. It also shows how, no matter how much time has elapsed, pathogenic factors must be expelled.

It is also interesting to note that this patient reported having many times sexual intercourse without any protection, and despite that, never getting pregnant. This is probably due to the fact that Cold has been blocking the Uterus, and thus preventing fertilization: this is infertility from a Shi (Full) condition.

Further information on Warm the Menses can be found at http://maciociaonline.blogspot.com.es/2015/02/focus-on-remedy-warm-menses.html

Friday, April 10, 2015

MEN: A COMMON MENTAL-EMOTIONAL SYMPTOM

Menis a common symptom in Chinese medicine.  The Chinese character shows a door and a heart inside itThus, it would seem to indicate a heart constricted by a door closing on it.  I translate this  symptom as “a feeling of oppression of the chest”.  Men is very difficult to translate and my translation is an attempt to convey the meaning of this symptom: it certainly does not claim to be the “correct” translation of men as most Chinese medicine terms have multiple, simultaneous meanings.


Chinese patients will actually use the term men: they might say, for example, “I sleep badly, I have a bitter taste and feel men.” In my experience, when a Chinese patients says that it means they are depressed. 

A feeling of oppression of the chest is purely subjective: there is nothing to be observed or palpated  (as there is in feeling of fullness or distension).  Some patients would describe it as a “feeling of weight” on the chest.  Other patients may use the term “tightness of the chest.” 
Men indicates Phlegm or severe Qi stagnation.  Men occurs in the chest or, less frequently, in the epigastrium; it does not occur in the lower abdomen. 
   
The term men first appears in chapter 19 of the Su Wen where it is described as a feeling of fullness of the chest with anxiety and blurred vision.

There is another condition characterized by men called “Rising Men Qi” (Men Qi Sheng), a condition that affects newborn babies.  It is characterized by a feeling of men in the umbilical area, the baby is not crying and has difficulty breathing.[i]

Men is rich in meaning and, in my experience, it describes not only a physical sensation in the chest but also a mental-emotional state of anguish associated with it.  A feeling of oppression of the chest reflects emotional stress especially to do with sadness, grief, worry, shame and guilt.  I find this symptom very common in the patients we see.

Chronic anxiety often manifests with the feeling of men in the chest and depression may also be accompanied by this symptom.

The presence of men indicates two things: first, that there is Phlegm; secondly, that the Lungs and/or Heart are involved. 

This Phlegm may be of a non-substantial kind and there may not necessarily be any expectoration of mucus (usually there is not).  Its main manifestation is precisely the feeling of oppression of the chest and possibly a Swollen tongue and a Slippery pulse. 



The main points I would use for a feeling of oppression of the chest are Ren-17 Shanzhong, Ren-15 Jiuwei, P-6 Neiguan, LU-7 Lieque and ST-40 Fenglong.

The main prescriptions that could be used are Ban Xia Hou Po Tang (Pinellia-Magnolia Decoction) or Wen Dan Tang (Warming the Gall-Bladder Decoction).



[i]  1980 Concise Dictionary of Chinese Medicine (Jian Ming Zhong Yi Ci Dian           
). People's Health Publishing House, Beijing, p. 476.

Tuesday, February 17, 2015

FOCUS ON A REMEDY: WARM THE MENSES

Warm the Menses is a variation of the well-known classical prescription Wen Jing Tang Warming the Menses Decoction by Zhang Zhong Jing (AD 150-219) from his book Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet).

The original prescription is as follows:

Wu Zhu Yu Fructus Evodiae rutaecarpae
Gui Zhi Ramulus Cinnamomi cassiae
Dang Gui Radix Angelicae sinensis
Chuan Xiong Rhizoma Chuanxiong
Bai Shao Radix Paeoniae
E Jiao Gelatinum Corii Asini
Mai Men Dong Tuber Ophiopogonis 
Mu Dan Pi Cortex Moutan radicis
Ren Shen Radix Ginseng
Ban Xia Rhizoma Pinelliae preparatum
Gan Cao Radix Glycyrrhizae uralensis
Sheng Jiang Rhizoma Zingiberis officinalis recens

The rationale behind it is as follows.  When Cold obstructs the Uterus, it makes Blood stagnate.  When Blood stagnates, new Blood has nowhere to go and it cannot be contained in the Uterus: this induces a deficiency of Blood.

A long-standing Blood deficiency may give rise to some Empty Heat signs, which may mistakenly be interpreted as Heat signs; but the Pale-Purple colour of the tongue clearly indicates that this is not so.  In fact, the original text refers to a parched mouth and lips as the symptoms of Empty Heat from Blood deficiency.

When used for its proper pattern of long-standing internal Cold occurring against a background of Deficiency and leading to stasis of Blood, this formula is very effective. An essential sign for its use is that the tongue-body colour be Pale or Bluish-Purple.

Explanation
- Wu Zhu Yu, Gui Zhi and Sheng Jiang warm the Uterus and expel Cold.
- Dang Gui, Chuan Xiong and Bai Shao nourish and invigorate Blood, which is necessary because the   obstruction of the Uterus by Cold prevents new Blood from taking its proper place there.
- Ren Shen tonifies Qi to nourish Blood.
- Mai Men Dong and E Jiao nourish Blood and Yin.
- Mu Dan Pi clears any Empty Heat which might arise from Blood deficiency.
- Ban Xia harmonizes the Uterus via the Stomach channel to which it is connected through the Chong   Mai.
- Gan Cao harmonizes.

Bluish-Purple left side (Uterus)


Bluish-Purple right side (Uterus)

The following are the ingredients of Warm the Menses:

Wu Zhu Yu Fructus Evodiae
Gui Zhi Ramulus Cinnamomi cassiae
Rou Gui Cortex Cinnamomi 
Dang Gui Radix Angelicae sinensis
Chuan Xiong Rhizoma Chuanxiong
Bai Shao Radix Paeoniae 
Dang Shen Radix Codonopsis
Mai Men Dong Radix Ophiopogonis
Mu Dan Pi Cortex Moutan radicis
Ban Xia Rhizoma Pinelliae preparatum
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata
Shu Di Huang Radix Rehmanniae preparata
Yan Hu Suo Rhizoma Corydalis
Wu Yao Radix Linderae
Yi Mu Cao Herba Leonuri
Du Zhong Cortex Eucommiae ulmoidis

Patterns: Stagnation of Cold in the Uterus, stasis of Blood, Blood deficiency, Kidney-Yang deficiency.

Actions: Expel Cold, warm the Uterus, invigorate Blood, eliminate stasis, nourish Blood, tonify and warm Kidney-Yang.

Indications: very painful periods with pain of a spastic character that is alleviated by the application of heat (such as a hot-water bottle), red or dark menstrual blood with small, dark clots, a pronounced feeling of cold that is aggravated during the period, late periods, irregular periods, infertility from Cold obstructing the uterus, bright-pale complexion, weariness, tiredness, backache, frequent pale urination, occasionally a slight feeling of heat in the face and a dry mouth or lips.
Tongue: Pale, wet.
Pulse: Deep, Tight, slow.

IN A NUTSHELL: expel Cold from the Uterus, invigorate Blood, nourish Blood, tonify Kidney-Yang. The two main indications for this remedy are painful periods and infertility from Cold in the uterus.

The main differences from its classical antecedent are that it tonifies Kidney-Yang and it invigorates Blood.

Bluish-Purple


Bluish-Puirple

END NOTES
1. He Ren 1981 A New Explanation of the Synopsis of Prescriptions from the Golden Cabinet (Jin Gui Yao Lue Xin Jie), Zhejiang Science Publishing House, p. 188.

Friday, January 30, 2015

SEXUALITY IN CHINESE MEDICINE PART 4: SEXUALITY AND EMOTIONAL PROBLEMS

This is the fourth and last part of Sexuality in Chinese Medicine.

Chinese medicine has always stressed the importance of excessive sexual activity as a cause of disease but not insufficient sexual activity.  This has not always been so as, during past dynasties, all sex manuals explicitly say that sexual activity is essential for the health of both men and women.  Indeed, sexual abstinence was viewed with suspicion (as Buddhist nuns were).

The current pruderie of Chinese medicine is clearly a result not so much of the Communist influence but of the Qing dynasty’s Confucian influence.  As we have seen, the Confucianists frowned upon sexual activity and believed that it should be carried out in secret and there should be no public display of affection (as in modern China until recently).

It is important to understand, however, that these rules did by no means imply that sex was a “sin” and woman was the origin of such sin as in the Christian view: nothing could be further from the truth.  The Confucianist abhorrence of sexual philandering was determined mainly by the fear that promiscuity might disrupt the sacred family life, and also by their reverence for the process of human procreation, a solemn process that must not be debased by superfluous amorous play.

Therefore, although the Confucianists considered women as inferior to men, this idea appeared natural to them as that of Earth being inferior to Heaven, thus inferior in a philosophical sense rather than in a concrete sense; it did by no means imply that they hated or despised women, as many medieval Christian thinkers and mystics did.

Moreover, women had their own vested rights, and one of them was the right to satisfaction of their sexual needs.  Although physical contact was strictly limited to the marital bed, there the husband had to give all his women the personal attention he was supposed to deny them as soon as they had left the bed.  The Li Ji (one of the Confucian classics) mentions sexual neglect of one of the women as a grave offence; neither age nor beauty should make the husband deviate from the strict protocol set for sequence and frequency of his sexual intercourse with his wives and concubines.

As we have seen, from the latter part of the Ming dynasty onward, Chinese society became more and more straight-laced and frowning on matters of sex.  We have also seen how Chinese doctors considered lack of sex and sexual frustration as a major cause of emotional stress in women: this is all the more likely to happen as, as we have seen, women’s sexuality is more complex than that of men and they therefore need a man who is expert in the sexual art and foreplay.

Sexual desire depends on the Minister Fire and a healthy sexual appetite indicates that this physiological Fire is abundant.  When sexual desire builds up the Minister Fire blazes up and Yang increases: the orgasm is a release of such accumulated Yang energy and, under normal circumstances, it is a beneficial discharge of Yang-Qi which promotes the free flow of Qi.

When sexual desire builds up, the Minister Fire is stirred: this affects the Mind and, in the terms of organs, specifically the Heat and Pericardium.  The Heart is connected to the Uterus via the Uterus Vessel (Bao Mai) and the orgasmic contractions of the uterus discharge the accumulated Yang energy of the Minister Fire.

When sexual desire is present but does not have an outlet in sexual activity and orgasm, the Minister Fire can accumulate and give rise both to Blood Heat and to stagnation of Qi in the Lower Burner.  This accumulated Heat will stir the Minister Fire further and harass the Mind, while the stagnation of Qi in the Lower Burner can give rise to gynaecological problems such as dysmenorrhoea.

Of course, if sexual desire is absent, then lack of sexual activity will not be a cause of disease.  Conversely, if one abstains from sexual activity but the sexual desire is strong, this will also stir up the Minister Fire but without release.  Thus, the crucial factor is the mental attitude.

With regard to sexual frustration, Qing dynasty’s Chen Jia Yuan wrote very perceptively about some women’s emotional longing and loneliness.  Among the emotional causes of disease he distinguishes “worry and pensiveness” from “depression”.

He basically considers depression, with its ensuing stagnation, due to emotional and sexual frustration and loneliness.  He says: “In women...such as widows, Buddhist nuns, servant girls and concubines, sexual desire agitates [the mind] inside but cannot satisfy the Heart.  The body is restricted on the outside and cannot expand with the mind [i.e. the mind longs for sexual satisfaction but the body is denied it].  This causes stagnation of Qi in the Triple Burner and the chest; after a long time there are strange symptoms such as a feeling of heat and cold as if it were malaria but it is not.  This is depression”.

Although the above thoughts derive from Dr Chen’s clinical experience with servant girls, Buddhist nuns and concubines and should therefore be seen in the social context of the Qing dynasty, they also have relevance to our times as he is essentially talking about sexual frustration and loneliness and his reference to widows confirms this (in old China widows were shunned and seldom remarried).  He perceptively refers to sexual craving agitating the Heart and Mind but not finding a satisfaction in the body: besides sexual frustration, he is also referring to emotional frustration and craving for love.

A constant theme of all this was also SEPARATION: the emotions resulting from separation (sadness and grief) are often at the root of Qi stagnation, not of the Liver, but of the Heart and Lungs and some times development of breast lumps and breast cancer.  It is important to realize that stagnation of Qi comes not only from the Liver but also from Lungs and Heart, especially Lungs.  In fact, even emotions that cause depletion of Qi such as sadness and grief, may cause stagnation of Qi (of the Lungs) because, when Qi is depleted in the chest, it does not circulate well and therefore stagnates.

In the particular case of breast lumps, the stagnation of Qi of the Lungs and Heart is particularly relevant because these two organs and channels are situated in the chest.  Zhu Dan Xi says: “When a woman is worried and depressed, accumulation develops, Spleen-Qi becomes weak, Liver-Qi rebels horizontally, stagnant Qi turns into nodules like turtle eggs, there is no pain or itching.  After 10 years ulcers develop and the disease is called Ru Yan [breast cancer]”.


This statement clearly points out the emotional influence on the development of the disease and also its long term development.  It is important to remember that stagnation of Qi in women is very often secondary and the consequence of a deficiency of the Liver and Kidneys affecting the Ren and Chong Mai.

The “Orthodox Manual of External Diseases” (Wei Ke Zheng Zong) written by Chen Shi Gong in 1617, says: “Depression injures the Liver, pensiveness affects the Spleen, accumulation develops in the Heart, the channel-Qi stagnates and generates [breast] nodules”.

The modern doctor Xia Shao Nong thinks that breast cancer is due to widowhood, breaking of relationships, divorce, death of one’s children, bereavement at a young age from the loss of one’s spouse.  These events, especially if occurring suddenly, upset the mind and lead to Qi stagnation.  It is interesting that all the events this doctor cites have to do with separation.

The Uterus Vessel (Bao Mai) connects the Uterus to the Heart: since the Heart is always affected by emotional problems (because it houses the Shen), this connection explains the profound influence of emotional stress on the menstrual function.  For example, the “Su Wen” in chapter 33 says: “When menstruation does not come, this is due to the Uterus Vessel being blocked.  The Uterus Vessel pertains to the Heart and connects with the Uterus; when Qi rebels upwards towards the Lungs, Heart-Qi cannot flow downwards and the periods do not come”.  “Qi rebelling upwards towards the Lungs” describes in particular the effect of worry, sadness or grief.



Emotional problems are all the more detrimental in women if they occur around the time of puberty.  At this time, a girl’s health is particularly vulnerable and emotional problems will affect her body and mind deeply and with long-lasting effect.  In particular, emotional stress at this time will deeply affect the Ren and Chong Mai creating the imbalances that will cause gynaecological problems later in life.

Emotional stress influences menstruation by affecting the movement of Blood by Qi.  In fact, the first effect of emotional stress is to impair or alter the circulation of Qi by depleting Qi, making Qi stagnant or making Qi rebellious.  Each of these pathologies will affect Blood which follows Qi and becomes deficient, stagnant or rebellious.

The “Golden Mirror of Medicine” says: “Women are frequently affected by worry, pensiveness, anger or depression: these make the Blood move, stop, rebel or conform, which is all due to Qi movement”.

Qing dynasty’s Chen Jia Yuan wrote with regard to worry: “Worry injures the Lungs and pensiveness injures the Spleen, when these two organs are injured Qi and Blood stagnate, there is a feeling of indignation, palpitations, a feeling of oppression of the chest and amenorrhoea”. This passage confirms that stagnation of Qi affects not only the Liver but also that amenorrhoea may occur from stagnation as well as from a deficiency.

Thus, considering the social position of women in ancient China and the frequency of the above-mentioned emotional and sexual frustrations, it is no wonder that Qi stagnation (not always of the Liver) occupies such a central place in women’s pathology, and we can also conclude that emotional stagnation in women was often the result of sexual frustration, separation and loneliness: these are the recurrent “anger” in Chinese medicine books.

This is essentially the clinical meaning and application of Xiao Yao San.  As sexual frustration in women is fairly common in our society (often deriving from men’s sexual inadequacy or inexperience), Dr Chen’s observations on the influence of sexual frustration on stagnation of Qi and depression acquire particular relevance.  This is often a cause of disease somewhat akin to emotional stress.

However, Xiao Yao San may work less well in modern women who have weaker Kidneys than in the past: there is no point in “moving Qi” is there is no Qi to move.  This is, in my opinion, the reason why Xiao Yao San does not work so well in modern women unless it is modified with the addition of some Kidney tonics.

                                       CONCLUSION

What have we got to learn from Daoist sex? One thing that stands out is how the Daoist sex manuals never mention “love”.  Sex seems to be an exercise in moving Qi, releasing the Minister Fire and exchanging Yin and Yang essences with the partner. Both the Daoists and the Confucianists removed love for different reasons and never mention love (although the old poems do).  The modern Chinese have even removed the “heart” from the “love” ideogram!




Modern character for "love" (ai)




Old character for "love"




Heart (xin)





However, there are some useful lessons for us:

1. Differences between men’s and women’s sexuality: many men could learn from that.
2. Importance of women’s orgasm and sexual frustration as cause of Qi stagnation.
3. Importance of men’s expertise in sexual techniques and foreplay.
4. Blow the myth of simultaneous orgasm and the importance of orgasm in men. If the man is         particularly experienced, the woman could have multiple orgasms before his.
5. Western sexuality fixed on orgasm, hence Western men often unskilled: this causes female frustration.  Modern men can learn from Daoist sex to allow for the difference between Water and Fire and therefore women’s slower response.

END NOTES
1. Chen Jia Yuan 1988 Eight Secret Books on Gynaecology (Fu Ke Mi Shu Ba Zhong).  Ancient Chinese Medical Books Publishing House, Beijing, p.152.  Chen’s book, written during the Qing dynasty (1644-1911) was entitled Secret Gynaecological Prescriptions (Fu Ke Mi Fang), and published in 1729.

2. 1979 The Yellow Emperor’s Classic of Internal Medicine - Simple Questions (Huang Di Nei Jing Su Wen), People’s Health Publishing House, Beijing, first published c. 100 BC, p.197.

3. Golden Mirror of Medicine (Yi Zong Jin Jian), p.9.

4. Eight Secret Books on Gynaecology, p.152.

Monday, January 12, 2015

SEXUALITY IN CHINESE MEDICINE - PART 3

SEXUALITY AND THE EXTRAORDINARY VESSELS

Human sexuality is closely linked to the physiology and pathology of the extraordinary vessels, especially the Du, Ren and Chong Mai.

The Du and Ren Mai are the expression of Fire and Water respectively with regard to sexuality: the exchange of sexual essences and of Yin and Yang during sexual intercourse takes place through the intertwining of the Du and Ren Mai during intercourse.


Both these vessels arise from the space between the Kidneys where the Yuan Qi throbs: they then flow down to the perineum where they separate, one following the spine up to the brain, the other following the front up to the face and eyes.  However, internally they intersect and both flow through the heart.

The “Su Wen” in chapter 60 has the following pathway for the Du Mai: it starts near the uterus, goes down to the pubic bone, in women to the vagina.  Its Luo channel goes around the vagina, passes to the perineum, then the buttocks, down to meet the Kidney and Bladder channels inside the upper thighs; it then rises up the spine and wraps around the kidneys.  In men it goes around the penis and then the perineum.  We can therefore see that, besides flowing up the back, the Du Mai flows to the genitals and is therefore stimulated by sexual intercourse.



Chapter 60 of the Su Wen also describes an abdominal branch of the Du Mai that starts in the abdomen, goes up to the umbilicus, past the heart, throat, chin, around lips and reaches the eyes.

Some see this “main vessel” as being the Ren Mai.  In fact, what it means is that the Du and Ren Mai are almost like two branches of the same vessel, one Yang and one Yin, intersecting inside.  Li Shi Zhen says: “The Du and Ren Mai are like midnight and midday, they are the polar axis of the body...there is one source and two branches, one goes to the front and the other to the back of the body...we can make connections between them.  When we try to divide these, we see that Yin and Yang are inseparable.  When we try to see them as one, we see that it is an indivisible whole.



Wang Big considered this “main vessel”, not as the Ren Mai but as a branch of the Du Mai flowing with the Ren Mai: “Another branch [of the Du Mai] starts in the lower abdomen, comes up the abdomen, to the centre of the eyes, following the pathway of the Ren Mai.  This is why we can say that the Du, Ren and Chong Mai have different names, but are all the same.”

Thus, the Du Mai embodies the Minister Fire and the Ren Mai Water: the contact of the penis inside the vagina establishes the link between the Du and Ren of the man and woman and therefore the exchange of Yin and Yang sexual essences between them.

Moreover, if the partners also kiss simultaneously, the communication between the Du and Ren is established not only below but also above as the Du Mai ends on the upper gum and the Ren Mai flows to the mouth, thus completing the circle.



THE THREE DAN TIAN
The three dan tians are of course closely linked to the Du and Ren Mai.

Upper Dan Tian: this is variously identified as the point Yintang, Du-20, a point between the eyes, the centre of the brain called “ni wan” or the centre of the chest.  In any case, all these points are either on the Du or the Ren Mai.

Middle Dan Tian: on the Ren Mai, Ren-12.

Lower Dan Tian: generally below the navel, could be Ren-6, Ren-5, Ren-4.

There are actually three Dan Tian on the same level: one anterior on the Ren, one in the middle on the Chong and one posterior on the Du (Du-4).



Some Chinese sex manuals give three different locations for women:

Upper Dan Tian: the breasts.
Middle Dan Tian: the navel itself.
Lower Dan Tian: the uterus.



THE THREE PASSES

The three passes are also along the Du Mai; they are like energetic bottlenecks through which Qi has to pass in its ascent to the brain.  The lower pass is at the coccyx; the middle is in the middle of the thoracic vertebrae; the upper is at the occiput.



THE NINE ORIFICES

The nine orifices in sex manuals are different than the usual ones (eyes, ear, etc.): they are the three dans tians, the three passes and the three points: these last three are Du-20, Ren-1 and the point called niwan (centre of the brain).  The three dan tians, three passes and three points form a circuit which is activated during sexual intercourse.

In the pre-natal life, the Du and Ren Mai are connected, whilst after birth, they are severed.  The connection can be re-established through the two “magpie bridges”, in the mouth (holding pressing the tongue upwards on the palate) and in the anus (by contracting the anal sphincter).  Both these manoeuvres are effected during Ba Gua exercises and the first during Tai Ji Quan and Xing Yi.

THE THREE PEAKS

The Three Peaks are related to the Ren and Chong vessels.  In a woman, the Three Peaks are the mouth, breast and vagina: during intercourse, the man can absorb a nourishing Qi and fluids from these three peaks.

The upper Peak is called Red Lotus Peak and its medicine is called Jade Fountain; the middle Peak is called the Double Lotus Peak and its medicine is called the Peach of Immortality; the lower Peak is called Peak of Purple Agaric, Grotto of the White Tiger or Mysterious Gateway and its medicine is called White Lead or Moon Flower.


PEAK               NAME                                   MEDICINE

Mouth               Red Lotus Peak                     Jade Fountain

Breast               Double Lotus Peak                Peach of Immortality

Vagina              Peak of Purple Agaric           White Lead
                          Grotto of the White Tiger      Moon Flower
                          Mysterious Gateway        



The mouth is related to both Ren and Chong Mai, the breast to the Chong and the vagina to the Ren Mai.  It should be clarified here that the man absorbs the vaginal secretions not through fellatio but through his penis.

The Kidneys and the Ren Mai are related to the salivary glands: the Qi of the Kidneys is stimulated during sexual intercourse, it rises in the Du Mai, flows into the mouth and is transformed into sweet salivary elixir.  This saliva is considered to be a Kidney tonic and should be swallowed while mentally directing it to the Lower Dan Tian.  For this reason, absorbing the woman’s energy and fluids from the Upper Peak is particularly beneficial.



Monday, December 29, 2014

SEXUALITY IN CHINESE MEDICINE - PART 2

DAOIST SEXUAL PRACTICES

The essence of Daoist sexuality is the idea that the sexual act is an exchange of Yin and Yang essences, from the woman and man respectively, which is beneficial to each partner: it represents the harmonious interaction and mutual nourishment of Yin and Yang.

Central to Daoist sexuality is the idea that man must conserve its sperm and only ejaculate occasionally: this is because sperm is a direct physical manifestation of Jing and too frequent ejaculation depletes Jing. If sperm is not ejaculated and directed upwards along the Du Mai to the brain, it can be transmuted and then lowered down to the Dan Tian where it nourishes the body and mind.

Since excessive ejaculation weakens the Jing, and since sex without ejaculation can replenish the Jing, it follows that Jing lost through sexual activity can be replaced by sexual energy itself, by practising sex without ejaculation.

Sexual intercourse was considered to have two aims: first to produce sons who would continue the family (and look after the parents' grave). This was a sacred duty to one's ancestors since the well-being of the dead could only be ensured by regular sacrifices made by their descendants, especially the male ones.

The second aim (more relevant to us) was to strengthen a man's vitality by making him absorb the Yin essences of the woman. As a matter of course, these two aims were closely interwoven. 

In order to obtain healthy male children the man's Yang essence should be at its apex when he ejaculates, and ancient sex manuals frequently pointed out the optimal conditions the best conditions for a healthy child: at the time of ejaculation and subsequent conception, the man should not be in a state of exhaustion and should not drink alcohol, for example.

To the Daoists, sex was like a process of alchemy, of transformation of the sexual essences into Qi and Jing, through the harmonious intermingling of Yin and Yang. They identified the woman with a crucible and her vital essence with cinnabar (red); they identified the man's white semen with lead; the coitus with the mixing of the elements, and the technique of the coitus with the firing times.

Since men had to restrain themselves by not ejaculating whereas women could reach an orgasm whenever they liked, the onus was very much on men to conduct and prolong sexual intercourse by sexual expertise; in fact, because of this, sexual intercourse is often described by the Daoists as a "battle", as "riding a tiger", or as "walking on the edge of a precipice": i.e. man is easily aroused and easily ejaculates and must learn to control his ejaculation to prolong sexual intercourse (see below).

There were also social reasons for this as the sexual art was essentially for the upper classes whose men had a wife and concubines and they therefore had to restrain themselves in order to satisfy them all.

A constant theme running through Daoist sex manuals is that excessive ejaculation is detrimental to health. This is because too frequent ejaculation leads to a direct loss of Jing and also Minister Fire: thus it depletes both Water and Fire. As we all know, this is very much a theme of modern Chinese medicine books where "excessive sexual activity" features prominently in the aetiology of diseases. As I will explain below, I think that this cause of disease does not apply to women.

The role of the Ming Men (Minister Fire) in human physiology should be discussed. The Fire of Ming Men represents the physiological Fire within the Kidneys, it arises from the area between the two kidneys and is closely related to the Yuan Qi from which the Du, Ren and Chong Mai originate. 

Under physiological conditions, the Fire of Ming Men warms the Uterus, the Intestines, the Bladder and the Heart and balances the Yin influences: it makes conception possible and is related to sexual desire. In women, "it is through Kidney-Yang [and therefore the Fire of Ming Men] that the Tian Gui turns red [i.e. it turns into Blood]".1

The Fire of Ming Men is the origin of the "formless" Minister Fire which also generates Water, hence the Kidneys are the source of both Water and Fire. This physiological Fire is unique in that, not only it does not dry up Water, but it can nourish Water. 

The Minister Fire is called "formless" because it is a non-substantial Fire which actually generates Water rather than overcoming it. It is a Pre-Natal type of Fire formed at conception on the Du/Ren Mai axis.

In fact, the "Golden Mirror of Medicine" (1742) says: "The Pre-Natal Tian Gui originates from the mother and father, the Post-Natal Jing and Blood are derived from food and water, a girl's Tian Gui matures at 14, when the Ren Mai is open, the Chong Mai is flourishing and the periods arrive".2

The commentary then explains: "At 7 the Motive Force [Dong Qi] is flourishing. At 14 the Tian Gui matures: this is the Motive Force within the Pre-Natal Water of Tian Gui, crystallizing in a girl's uterus".3

"Motive Force" (Dong Qi) is the Yuan Qi. This last passage is interesting as it confirms that the Yuan Qi and the Minister Fire are pre-natal and present before the onset of the periods. It also highlights the close integration of the Minister Fire and the Tian Gui (the Yang and Yin aspects of the Kidneys).

Zhang Jing Yue says: "The Ming Men is the Root of the Yuan Qi and the residence of [both] Water and Fire. The Yin of the 5 Zang cannot nourish without it and their Yang cannot develop without it".4  

This passage clearly shows how the Minister Fire is the Fire within Water, interdependent with Water and inseparable from it. The Emperor Fire (of the Heart) is called "with form", i.e. it is a substantial Fire which overcomes Water, is formed after birth and is therefore post-natal.

It is important to note again that the Minister Fire cannot be seen in the context of the Five Elements, it is not like the Fire of the Heart and it is a Fire within Water of the Kidneys that actually nourishes Water.

DIFFERENCES BETWEEN WOMEN'S AND MEN'S SEXUALITY

Women pertain to Water and men pertain to Fire and there are important differences in their sexuality. Women are like water, i.e. slow to bring to the boil and slow to cool down; men are like fire, i.e. easy to arouse and quick to cool down. 

Ever since very early times, Chinese sexual manuals stressed that women like "slowness" and "duration" and abhor "haste" and "violence". This difference is the crux to understand the different sexual behaviour by men and women necessary or a successful sexual life. For this reason, all Daoist texts stressed very much the importance of expert foreplay by the man to arouse his partner and hence the detailed description of the signs of women's arousal.

The Five Signs of sexual arousal in a woman are:

1) Flushing of the face, indicating arrival of Heart-Qi;
2) Hardening of the nipples and sweating around her nose, indicating arrival of
     Liver-Qi;
3) Parched throat, dry lips indicating arrival of Lung-Qi;
4) Moistness of the vagina, indicating arrive of Spleen-Qi;
5) Extreme moistness of the vagina with dripping of thick, viscous fluid, indicating
     the arrival of Kidney-Qi.

Others have the Five Signs as follows:

1) Flushing of the face: Heart-Qi;
2) Moist eyes with an expression of love: Liver-Qi;
3) Speechlessness with head lowered: Lung-Qi;
4) Pressing her body close to the man's body: Spleen-Qi;
5) Dilation and moistness of the vagina: Kidney-Qi.

The Five Desires are:

1) "Intent": manifested by short, shallow breathing and a rapid pulse.
2) "Awareness": she wishes the man to touch and stimulate her genitals: indicated by flared nostrils and parted lips.
3) When a woman approaches the peak of passion, her entire body shakes and she clutches the man closely.
4) Occurs during orgasm and is called "Concentration": the woman sweats.
5) Occurs only in a state of extreme passion and pleasure beyond normal orgasm: her body straightens and grows rigid, her eyes close and she clamps her thighs tightly together around the man.

Thus, it can be seen that much of the instruction is directed at men, teaching them how to conduct foreplay, how to arouse the woman, how to detect the signs of her arousal and her intentions and how to delay ejaculation. This is because of the above-mentioned biological difference between men and women, i.e. women are "slow to heat up" whilst men are "quick to flare up and become extinguished": thus the onus is very much on men to control themselves to give time to the woman to reach arousal and orgasm.

From the point of view of Chinese medicine, there are important differences between men's and women's sexuality. In men, the lower Dan Tian contains the "Room of Sperm" and is, so to speak, "empty"; in women, the lower Dan Tian is, so to speak, "full" as it contains the Uterus and Blood. Excessive sexual activity does not affect women as much as men for various reasons. 


 
In men, ejaculation is a direct (but temporary) loss of Jing as sperm is derived directly from the Jing.   Sperm is Tian Gui whereas Tian Gui in women is menstrual blood and ovarian follicles and eggs. As in sexual activity men lose sperm but women do not lose menstrual blood (unless they have sex during the period which they should not do) or follicles.

As there is no comparable loss of Jing in women as there is in men, there is no equivalent depletion after sex. Quite simply, the Kidney-Jing is the origin of sperm in men and of menstrual blood and ova in women: while men lose sperm during sex, women do not lose menstrual blood or ova.

Although some practitioners consider the lubricating fluids secreted by the Bartholin's glands during sexual arousal in a woman to be also a manifestation of Jing comparable to sperm, I tend to disagree because such fluids are secreted by glands in the vagina and not by sex organs (such as the ovaries in women or testicles in men): I would therefore consider these fluids precisely as a form of Body Fluids (jin ye) rather than a direct manifestation of Jing. In fact, the Bartholin's glands in the vagina are homologous to the Cowper's glands in men and their function is purely lubricative.

In other words, sperm is a direct manifestation of Jing, the equivalent of which would be the ova and menstrual Blood in women: the former is lost in men's orgasm, the latter are not lost in women's orgasm.

Furthermore, the Lower Dan Tian in men contains the Room of Sperm which is directly related to Jing, while in women it contains the Uterus which is related to Blood. The Room of Sperm is related to the Kidneys while the Uterus is related also to the Liver and Blood (although also to the Kidneys through the Bao Luo). Because the Lower Dan Tian in women contains the Uterus rather than the Room of Sperm, in women excessive loss of blood after childbirth or excessive loss of blood in menorrhagia would be equivalent to excessive sex for men.

In men, the lower abdomen is occupied by the Room of Sperm and it is therefore "empty", also because sperm is easily discharged while Blood is not. 

The book "Elementary Medicine" (1575) says: "The Room of Sperm in men suffers no accumulation or fullness, while the Blood Chamber in women suffers from accumulation and it overflows downwards in the period....[The Lower Dan Tian] in men stores Jing [=sperm] while in women it stores the Uterus and foetus.  Men pertain to Qi and when it mixes with the Abysmal [the trigram corresponding to Water], Qi makes Water steam and produces sperm which is white... Women pertain to Blood, when this mixes with the Clinging [the trigram corresponding to Fire], Blood is transformed into the period which is red".5




END NOTES
1. Cong Chun Yu 1989 Chinese Medicine Gynaecology (Zhong Yi Fu Ke Xue), Ancient Chinese Medicine Texts Publishing House, Beijing, p.11.
2. Wu Qian 1977 Golden Mirror of Medicine (Yi Zong Jin Jian), People's Health Publishing House, Beijing, vol. 3, p.7.  First published in 1742.
3. Ibid., p. 7.
4. Zhang Jing Yue 1986 The Complete Works of Jing Yue (Jing Yue Quan Shu), Shanghai Science and Technology Press, Shanghai, p.19.  First published in 1624.
5. Elementary Medicine (Yi Xue Ru Men ) 1575 cited in Zhang Qi Wen 1995 Menstrual Diseases (Yue Jing Bing Zheng), People's Hygiene Publishing House, Beijing, p.10.